Section 1: Policy Statement(Effective Date of Program)
Our establishment, [Employer Name] is committed to our employees’ safety and health. We refuse to tolerate any form of violence in the workplace and will make every effort to prevent violent incidents from occurring by implementing a Workplace Violence Prevention Program (WVPP). We will provide adequate authority and budgetary resources to responsible parties so that our goals and responsibilities can be met.
All managers, supervisors and employees are responsible for implementing and maintaining our WVPP Program. We encourage employee participation in designing and implementing our program. We require prompt and accurate reporting of all violent incidents whether or not physical injury has occurred. We will not discriminate against victims of workplace violence.
A copy of this policy statement and WVPP Plan is readily available to all employees and from each manager and supervisor.
Our plan ensures that all employees, including supervisors and managers, adhere to work practices that are designed to make the workplace more secure, and do not engage in verbal threats or physical actions which create a security hazard for others in the workplace.
All employees, including managers and supervisors, are responsible and accountable for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe and secure work environment.
The management of our establishment is responsible for ensuring that all safety and health policies and procedures involving workplace security are clearly communicated and understood by all employees. Managers and supervisors are expected to enforce the rules fairly and uniformly.
The WVPP Plan will be reviewed and updated annually.
Section II: Responsibility and Accountability
The Workplace Violence Prevention Program Administrator is [Program Administrator] and (he/she) has the authority and responsibility for implementing the provisions of this program for [Establishment Name]. All managers, supervisors and employees are responsible for implementing and maintaining the WVPP in their work areas and for answering employee questions about the program.
In addition, a WVPP Planning Group will be established to assess the vulnerability to workplace violence at our establishment and reach agreement on preventive actions to be taken. This group will be responsible for developing employee training programs in violence prevention and plans for responding to acts of violence. They will also audit our overall Workplace Violence Prevention Program.
The Workplace Violence Prevention Group will consist of:
Name:_________________________________ Title:___________________ Phone:______________
Name:_________________________________ Title:___________________ Phone:______________
Name:_________________________________ Title:___________________ Phone:______________
Name:_________________________________ Title:___________________ Phone:______________
Name:_________________________________ Title:___________________ Phone:______________
Section III: Compliance
All employees are responsible and will be held accountable for using safe work practices, for following all directives, policies and procedures, and for assisting in maintaining a safe and secure work environment.
Managers, supervisors and employees will comply with work practices that are designed to make the workplace more secure, and will not engage in threats or physical actions which create a security hazard for others in the workplace. Managers and supervisors will:
Managers and supervisors will maintain an open, two-way communications system on all workplace safety, health and security issues. Our establishment has a communication system designed to encourage a continuous flow of safety, health and security information between management and our employees without fear of reprisal and in a form that is readily understandable. Our communication system consists of the following items:
Hazard Assessment
The Workplace Violence Prevention Group will perform workplace hazard assessment for workplace security in the form of record keeping and review, periodic workplace security inspections, and a workplace survey. The assessment group will identify workplace violence and security issues and make recommendations to management and employees.
Record Keeping and Review
Note: Care must be taken to ensure appropriate confidentiality of medical and personnel records, as required by the ADA (Americans with Disabilities Act) and other applicable regulations or policies.
Periodic updates and reviews of the following workplace violence reports and records will be made:
The records review will be performed on the following schedule: _______________.
Workplace Security Inspections
Periodic inspections to identify and evaluate workplace security hazards and threats of workplace violence will be performed by the following observer(s) in the following areas of our workplace:
Observer | Area |
Periodic inspections are performed according to the following schedule:
Periodic inspections for security hazards consist of identification and evaluation of workplace security hazards and changes in employee work practices, and may require assessing for more than one type of workplace violence. Our establishment performs inspections for each type of workplace violence by using the methods specified below to identify and evaluate workplace security hazards.
Inspections for workplace security hazards from violence by strangers (Type 1) include assessing:
Inspections for workplace security hazards from violence by customers or clients (Type 2) include assessing:
Inspections for workplace security hazards from violence by co-workers (Type 3) include assessing:
Inspection for workplace security hazards from violence by personal relations include assessing:
Workplace Survey
Under the direction of the Workplace Violence Prevention Administrator & Group, we
distributed a survey among all of our employees to identify any additional issues that
were not noted in the records review or the security inspection.
Based on the records review, workplace security inspections and workplace survey, the
Workplace Violence Prevention Group has identified the following issues that need to be
addressed: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Workplace Hazard Control and Prevention
In order to reduce the risk of workplace violence, the following measures have been
recommended: Engineering Controls and Building or Work Area Design: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Workplace Practices: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Management has instituted the following as a result of the workplace violence hazard
assessment and the recommendations made by the Workplace Violence Prevention Group: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ These changes were completed on (date). Policies and procedures developed as a result of the Workplace Violence Prevention
Group’s recommendations: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Training and Instruction We have established the following policy on training all employees with respect to
workplace violence and security. All employees, including managers and supervisors, shall have training and instruction
on general and job-specific workplace security practices. Training and instruction
shall be provided when the Workplace Violence Prevention Program is first established and
periodically thereafter. Training shall be provided to all new employees and to
other employees for whom training has not previously been provided. It shall also be
provided to all employees, supervisors, and managers given new job Exercises for which
specific workplace security training for the job Exercise has not previously been
provided. Additional training and instruction will be provided to all personnel whenever
the employer is made aware of new or previously unrecognized security hazards. General workplace violence and security training and instruction includes, but is not
limited to, the following: In addition, we provide specific instructions to all employees regarding workplace
security hazards unique to their job Exercise, to the extent that such information was
not already covered in other training. We have chosen the following items for training and instruction for managers,
supervisors and employees: Incident Investigation Our procedures for investigating incidents of workplace violence—threats and
physical injury—include: Source: Workplace Violence: Awareness and Prevention for Employers and Employees, Washington State Department of Labor and Industries
Copyright ©2000-2019 Geigle Safety Group, Inc. All rights reserved. Federal copyright prohibits unauthorized reproduction by any means without permission. Disclaimer: This material is for training purposes only to inform the reader of occupational safety and health best practices and general compliance requirement and is not a substitute for provisions of the OSH Act of 1970 or any governmental regulatory agency. CertiSafety is a division of Geigle Safety Group, Inc., and is not connected or affiliated with the U.S. Department of Labor (DOL), or the Occupational Safety and Health Administration (OSHA).